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HomeMy WebLinkAbout507242 CUSTOM SOLAR LLC - INSURANCE CERTIFICATECUSTS-2 OP ID: TLG CERTIFICATE OF LIABILITY INSURANCE °AT11/26i12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER - Phone: 303-996-7801 CRS Insurance Brokerage Fax: 303-757-7719 Commercial Risk Solutions DBA 6600 E. Hampden Ave. Denver, CO 80224 CONTACT NNONE FAX A/c Nu Est: Ac Na: - E MAIL n DRESS: - Jeffrey Berven rp INSURERS AFFORDING COVERAGE NAIC r INSURER A: Westfield Insurance INSURED Custom Solar LLC 2840 Wilderness Place, Ste F Boulder, CO 80301 INSURERS; Pinnacol Assurance INSURER c INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MM D/YYYY IY MMIDDYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea o=rrance $ - 500,00 A X COMMERCIALGENERAL LIABILITY CLAIMS -MADE LFZ17OCCUR X CWP0126613 11/10/12 11/10/13 MED EXP (Any one Person) - $ - 15,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidant $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO X CWPO126513 11/10/12 11/10/13 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ - 6,000,00 AGGREGATE $ 6,000,00 A EXCESS LIAB CLAIMS -MADE CWPO126513 11/10/12 11/10/13 DED I X I RETENTION$ O 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETORIPARTNERXECUTIVE YIN / OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N I A 4160305 11/20/12 11/01/13 X I WCSTATU- OTH- _LIM E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 Ify de scribe under DESCRIPTION OF OPERATIONS DeIow E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) City of Fort Collins, its officers, agents and employees are included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. CITYOFF City of Fort Collins Purchasing & Risk Management PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD